Lymphoma Nursing Care Plans Diagnosis and Interventions
Lymphoma NCLEX Review and Nursing Care Plans
Lymphoma is a term used to describe cancer that begins in the lymphatic system. Lymphomas are a diverse collection of cancers that emerge from the clonal proliferation of lymphocyte subsets such as B cells, T cells, and natural killer (NK) cells at various stages of maturation. It accounts for around 5% of all cancers. The overall survival rate is predicted to be around 72%.
Hodgkin lymphoma and non-Hodgkin lymphoma (NHL) are the two forms of lymphoma. Lymphoma can affect any part of the lymphatic system, including the following:
- Bone marrow
- Lymph nodes
Signs and Symptoms of Lymphoma
Lymphoma may be asymptomatic in the early stages of the disease. Swollen lymph nodes may be discovered during a physical examination. These can look like small and soft nodules under the skin. Lymph nodes can be felt in the neck, upper torso, armpit, stomach, or groin.
Similarly, many of the early lymphoma symptoms aren’t specific. As a result, they’re simple to overlook. The following are some of the most prevalent lymphoma early symptoms:
- spleen enlargement
- sweating during night
- Breathing problems
- itching on the skin
- stomach ache
- a decrease in appetite
- weight loss that isn’t explained
Because the symptoms of lymphoma are often neglected, detecting and diagnosing it at an early stage can be difficult. It’s crucial to understand how symptoms may alter as the cancer progresses.
Causes of Lymphoma
Lymphoma develops when lymphocytes, which are white blood cells, grow out of control. A lymphocyte cell’s usual life span is only a few minutes before it dies. DNA mutations inside lymphocyte cells in persons with lymphoma, on the other hand, cause them to thrive and spread rather than die.
Different environmental, viral, and genetic variables that predispose to lymphoma have been found.
- Occupational exposure. Herbicides and pesticides are used in the workplace.
- Infections. Helicobacter pylori (MALT lymphoma), Borrelia burgdorferi, Chlamydia psittaci, Campylobacter jejuni, human T-cell lymphotropic virus (adult T-cell leukemia/lymphoma), hepatitis C (lymphoplasmacytic lymphoma, diffuse large B-cell lymphoma, and marginal zone lymphoma), human herpesvirus 8, human her (primary effusion lymphoma and Castleman disease). Lymphoma formation is also increased by chronic activation of lymphoid tissue. Lymphoma is also predisposed by persistent infection with viruses such as Epstein Barr virus and CMV.
- Immunocompromised condition. HIV infection, transplant patients, and people with hereditary immunodeficiency illnesses (severe combined immunodeficiency and common variable immunodeficiency) are all examples of immunodeficiency.
- Drugs. Tumor necrosis factor-alpha inhibitors have been linked to T-cell lymphoma in particular. In post-transplant patients, chronic immunosuppression increases the risk of lymphoma (both in bone marrow transplant and solid organ transplant recipients).
- Autoimmune disorders. Inflammatory bowel disease (enteropathy related lymphoma), rheumatoid arthritis, and Sjögren’s syndrome are all autoimmune illnesses (diffuse large B-cell lymphoma)
- Geographic location. The incidence of extranodal NK/T-cell lymphoma is particularly high in Southern Asia and areas of Latin America.
It’s unclear what causes this DNA change, and while some risk factors for lymphoma have been identified, persons without these risk factors can still get these tumors.
Risk Factors to Lymphoma
The majority of lymphoma cases are diagnosed with no known cause. Some people, however, are thought to be at a higher risk.
- Non-Hodgkin’s Lymphoma
The following are some of the risk factors for NHL:
- Immunodeficiency. This could be the result of a weakened immune system caused by HIV or the use of an immune-suppressing medicine following an organ transplant.
- Autoimmune disease. Lymphoma is more common in people who have autoimmune illnesses such rheumatoid arthritis and celiac disease.
- Age. Lymphoma is more common in people over the age of 50. Certain varieties, however, are more common in children and newborns. Epstein-Barr virus (EBV) infection is linked to a higher risk.
- Exposure to chemicals and radiation. Pesticides, fertilizers, and herbicides all include compounds that put people at risk. Nuclear radiation has also been linked to an increased risk of getting NHL.
- Sex. Although men have a higher overall risk of NHL than women, specific forms of NHL are more likely to develop in women.
- Ethnicity. In the United States, white persons are more likely than African Americans or Asian Americans to get lymphoma.
- Infection. Infections such as the human T-cell leukemia/lymphocytic virus (HTLV-1), Heliobacter pylori, hepatitis C, or the Epstein-Barr virus (EBV) are linked to an increased risk of developing cancer.
- Size of the body. Obese people may be more likely to acquire lymphoma, but more research is needed to fully understand this putative risk factor.
The risk factors for Hodgkin’s lymphoma include the following:
- Age. People between the ages of 20 and 30 and those over 55 are more likely to be diagnosed with the disease.
- Sex. This form of lymphoma is more common in men than in women.
- Family history of cancer. If a sibling has been diagnosed with this type of cancer, the patient chances of getting it are increased.
- Mononucleosis contagious. Mononucleosis can be caused by an EBV infection. This infection has been linked to an increased risk of lymphoma.
- Immunodeficiency. HIV-positive people are more likely to develop lymphoma.
Diagnosis of Lymphoma
If a doctor suspects lymphoma, he or she will usually do a biopsy. This procedure entails extracting cells from a swollen lymph node.
A hematopathologist will study the cells to see if lymphoma cells are present and if so, what type of lymphoma cells they are. If the lymphoma cells are found by the hematopathologist, more testing can be done to determine how far the cancer has gone. These examinations may involve:
- an X-ray of the chest
- a blood test to determine the number of white and red blood cells
- lymph nodes or tissues in the area are tested
- A bone marrow aspiration is a procedure that involves extracting a small volume of liquid from the bone marrow and testing it.
- a lumbar puncture (spinal tap), which involves removing a small amount of fluid from the spine and testing it.
- an ultrasonography of the abdomen
Additional tumors or enlarged lymph nodes may be discovered through imaging studies such as CT or MRI scans.
Treatment for Lymphoma
To treat lymphoma, a team of medical experts usually works together:
- Hematologists are doctors whose expertise revolve around blood, bone marrow, and immune cell disorders.
- Oncologists are doctors who specialize in the treatment of cancerous tumors.
- Pathologists may collaborate with these doctors to help with treatment planning and determining whether a treatment is effective.
Treatment options are determined by a number of factors, including the patient’s age and overall health, the type of lymphoma they have, and the stage of their illness.
Doctors stage tumors to determine how far the cancerous cells have migrated. A tumor in stage 1 is limited to a few lymph nodes, but a tumor in stage 4 has spread to other organs like the lungs or bone marrow.
NHL tumors are also graded according to how quickly they grow. These are some of the terms:
- low-grade or non-aggressive
- aggressive or moderate grade
- exceedingly aggressive or high-grade
- Treatment for Hodgkin’s Lymphoma
In Hodgkin’s lymphoma patients, radiation therapy is widely utilized to shrink and eliminate malignant cells. Chemotherapy drugs may also be prescribed by doctors to kill malignant cells. Immunotherapy therapy medications like nivolumab and pembrolizumab, which assist the body’s T cells target cancer, are other newer treatments.
- Non-lymphoma Hodgkin’s Treatment
NHL is also treated with chemotherapy and radiation. Biological therapies that target malignant B cells have been shown to be successful. Nivolumab is an example of this sort of medicine.
CAR-T-cell therapy is part of the treatment for some people, such as those with large B-cell lymphoma (DLBCL). CAR T cell therapy treats cancer by using the body’s own cells: immune cells are extracted from the body, injected with new proteins in a lab, and then returned to the body.
A bone marrow or stem cell transplant may be utilized to rebuild healthy immune system cells in some cases of both Hodgkin’s lymphoma and NHL. These cells or tissues may be harvested by doctors before the start of chemotherapy or radiation therapies.
Prevention of Lymphoma
Non-Hodgkin lymphoma cannot be completely avoided (NHL). Because most persons with NHL have no modifiable risk factors, there is no method to prevent these lymphomas. However, there are certain things the patient can do to reduce the risk of NHL, such as reducing the patient’s exposure to certain viruses and doing everything the patient can to keep the patient’s immune system in good shape.
Some lifestyle factors have been related to a higher risk of lymphoma development. Any elevated risks are anticipated to be minor. The following actions, on the other hand, have been shown to lower the risk of numerous cancers and diseases:
- Avoidance of actions that raise the risk of contracting HIV/AIDS or hepatitis C
- Avoidance of exposure to radiation
- Smoking cessation
- Weight management
Lymphoma Nursing Diagnosis
Nursing Care Plan for Lymphoma 1
Nursing Diagnosis: Sexual Dysfunction related to changes in the structure or function of the body [drugs, surgery, disease process, radiation (loss of sexual desire, disruption of sexual response pattern)] secondary to lymphoma as evidenced by expression of the issue, disease and/or therapy-induced limitations, real or perceived, and changes in the patient relationship with the patient’s significant other (SO).
- The patient will verbalize individual reasons for sexual issues.
- The patient will identify lifestyle stresses that may be contributing to the problem.
- The patient will talk about his/her issues regarding body image, sex role, and desirability as a sexual partner with the patient’s partner/SO.
|Lymphoma Nursing Interventions||Rationale|
|Allow the patient to convey the situation in his or her own terms.||Provides a more realistic image of the patient’s experience, which can be used to design a treatment plan.|
|Recognize the significance of sex in a person’s, partner’s, and patient’s incentive for improvement.||Patients and partners in their productive years are more susceptible in developing lymphomas thus, these people may be more affected by these issues and less aware of the options for improvement.|
|Consider the patient’s and SO’s knowledge of sexual function as well as the impact of the current scenario and condition.||Aids in the analysis of areas of concern, misunderstanding, and actual problems associated with therapy side effects.|
|Determine whether or not there are any preexisting or ongoing stressors in the relationship.||Other concerns for the patient may include work, financial, and illness-related challenges.|
|Determine the pathophysiology, sickness, surgery, or trauma that is involved, as well as the influence on the individual’s (perception).||The patient’s perspective of the illness’s specific impacts is critical in developing solutions that are appropriate for those who are afflicted (patient and family).|
|Assist with the therapy of the underlying problem.||As the condition is treated and the patient sees progress, hope is restored, and the patient can begin to look forward.|
|Give accurate information.||This establishes trust in healthcare providers.|
|Accept and encourage expressions of worry, anger, grief, and fear.||Assists the patient in recognizing and dealing with their emotions.|
|Encourage the patient to discuss his or her ideas and worries with their partner, as well as to clarify their values and the impact of their condition on their relationship.||Aids a couple in dealing with challenges that might either strengthen or impair their relationship.|
|Refer to community resources and support groups as needed (CanSurmount).||Provides information about resources that can be used to assist with certain requirements. Meeting with others who are suffering with the effects of a life-threatening illness can be beneficial to the patient and their family.|
|Provide written materials, bibliotherapy websites, and other resources that are age and circumstance appropriate.||Reiterates what the patient has already learned.|
|As needed, see a mental clinical nurse specialist and a competent sexual therapist.||To remedy current issues, extra in-depth assistance may be required.|
Nursing Care Plan for Lymphoma 2
Ineffective Breathing Pattern
Nursing Diagnosis: Ineffective Breathing Pattern related to obstruction of tracheobronchial tree (enlarged mediastinal nodes and/or airway edema) (Hodgkin’s and non- Hodgkin’s) or superior vena cava syndrome (non- Hodgkin’s) secondary to lymphoma
Desired Outcome: The patient will maintain a normal/effective breathing pattern devoid of dyspnea, cyanosis, or other respiratory distress symptoms.
|Lymphoma Nursing Interventions||Rationale|
|Evaluate and track the patient’s breathing rate, depth, and rhythm. Dyspnea and the use of auxiliary muscles, nasal flaring, and a change in chest excursion have all been reported.||Changes (such as tachypnea, dyspnea, or the usage of accessory muscles) could signal that respiratory involvement and compromise is progressing, necessitating immediate action.|
|Place the patient in a comfortable position, such as elevated head of bed or sitting upright leaning forward (weight supported on arms) with feet dangling.||Increases lung expansion, reduces breathing work, and lowers the danger of aspiration.|
|Periodically reposition and aid with rotating.||All lung segments are aerated, and secretions are mobilized.|
|If necessary, instruct and assist with deep-breathing techniques, pursed-lip breathing, or abdominal diaphragmatic breathing.||Aids in the diffusion of gas and the enlargement of narrow airways. Allows the patient to have some control over their breathing, which can assist to relieve anxiety.|
|Monitor and analyze skin color, taking note of any pallor or cyanosis (particularly in nail beds, ear lobes, and lips).||WBC proliferation can impair the blood’s oxygen-carrying capacity, resulting in hypoxemia.|
|Evaluate the patient’s respiratory response to physical activity. Dyspnea or “air hunger,” as well as increased weariness, have been reported. Rest periods should be scheduled in between activities.||Activity tolerance is reduced when cellular oxygenation is low. Rest lowers oxygen needs while also reducing weariness and dyspnea.|
|Identify and promote energy-saving methods (use of shower chairs, rest periods before and after meals, , sitting for care).||Reduces tiredness and dyspnea while conserving energy for cellular renewal and respiration.|
|During acute and prolonged exacerbations, encourage bedrest and give treatment as needed.||To avoid more acute respiratory compromise, worsening respiratory involvement and hypoxia may demand a reduction in exercise.|
|Encourage others to express their emotions. Recognize the reality of the issue and the normalcy of the patient’s feelings.||Anxiety raises oxygen demand, and hypoxemia exacerbates respiratory distress and heart symptoms, causing anxiety to rise.|
|Maintain a calm and quiet environment.||Relaxes the body, saves energy, and reduces oxygen consumption.|
|Look out for signs of headache, dizziness, neck vein distension, periorbital and facial edema, dyspnea, and stridor.||Superior vena cava syndrome, which can cause tracheal deviation and airway obstruction in non-lymphoma Hodgkin’s patients, is an oncologic emergency.|
|Assist family members and caregivers. Encourage others to express their emotions openly.||The emergence of this complication is extremely scary for the patient and family since it may signify that the illness process is nearing its finish and that death is imminent, especially in a hospice situation. Keeping family members informed can help to reduce worry and transmission to the patient.|
|Supplemental oxygen should be provided.||Increases the amount of oxygen available for circulatory absorption and helps to prevent hypoxemia.|
|Keep an eye on the patient’s in the laboratory findings (ABGs, oximetry).||Measures the efficiency of therapy and the adequacy of respiratory function.|
|As needed, administer analgesics and tranquilizers.||Reduced physiological responses to pain and anxiety result in lower oxygen needs, which may help to prevent respiratory compromise.|
|If necessary, assist with respiratory therapies or adjuncts (IPPB, incentive spirometer).||Prevents atelectasis by promoting maximum aeration of all lung segments.|
|Assist in the intubation and mechanical ventilation of the patient.||Supporting respiratory function until airway edema is cleared in a critically ill hospitalized patient may be important.|
|If emergency radiation therapy is required, be prepared.||The preferred treatment for superior vena cava syndrome.|
Nursing Care Plan for Lymphoma 3
Nursing Diagnosis: Deficient Knowledge related to lack of awareness/recall, misinterpretation of data, unawareness of available information sources, and limitations in cognition secondary to lymphoma as evidenced by request for information, articulation of a problem, and utterances that reveal misunderstandings, inaccurate execution of instruction, and development of avoidable complications
- The patient will explain the condition, the prognosis, and any probable problems.
- The patient will determine the association between indications and symptoms and the disease process.
- The patient will make the appropriate lifestyle adjustments.
|Lymphoma Nursing Interventions||Rationale|
|Discuss any potential side effects that may occur as a result of a given therapy regimen.||Pneumonitis, hypothyroidism, pericarditis, and cardiomyopathy are all possible side effects and long-term physical problems of radiation (direct or indirect) and some chemotherapy treatments.|
|Emphasize the importance of continuing medical care.||In addition to the various risks indicated, there is an increased chance of secondary malignancies (thyroid, myeloid leukemia, non-lymphoma) Hodgkin’s after therapy. Female patients should get yearly Pap screenings because Hodgkin’s cells can be discovered on the cervix.|
|Cough, fever, chills, malaise, dyspnea (pneumonitis); weight gain, slow pulse, decreased energy level, intolerance to cold (hypothyroidism); moderate fever, chest pain, dry cough, dyspnea, rapid pulse (pericarditis); dyspnea, fatigue, chest pain, dizziness/syncope (pericarditis); dyspnea, fatigue, chest pain, dizziness/syn (cardiomyopathy).||Prompt intervention can help to slow the progression of a problem and lessen its severe effects.|
|Recommend moderate activity with appropriate relaxation on a regular basis. Techniques for energy conservation are discussed.||Enhances overall well-being. Fatigue is linked to the illness process, treatment regimen, and the development of complications. As a result, combining activity with rest improves the patient’s ability to execute ADLs.|
|Examine infection-prevention methods as well as signs and symptoms that require further investigation.||Both before and after treatment, the condition is linked to a complicated cellular immunity deficiency. Herpes zoster is a very prevalent infection.|
|Make a list of the patient’s financial requirements and worries. Locate community resources and vocational assistance.||Although survival rates are generally favorable, patients with dyspnea, persistent fatigue, and attention or memory problems commonly have limitations in their physical activities and work. The presence of the condition can also affect a patient’s ability to work, get a loan, or get insurance.|
Nursing Care Plan for Lymphoma 4
Risk for Infection
Nursing Diagnosis: Risk for Infection related to immunosuppression and insufficient secondary defenses, such as bone marrow suppression (dose-limiting side effect of both chemotherapy and radiation), malnutrition, progression of a chronic disease, and procedures that are invasive secondary to lymphoma.
- The patient will maintain afebrile status and heal as soon as possible.
- The patient will identify and participate in interventions aimed at preventing or reducing infection risk.
|Lymphoma Nursing Interventions||Rationale|
|Encourage workers and guests to wash their hands properly. Visitors who may be infected should be screened and limited. As directed, place in reverse isolation.||Protects the patient from infection sources such as visitors and workers with upper respiratory infections (URI).|
|Emphasize the importance of personal cleanliness.||Reduces the risk of infection and subsequent overgrowth.|
|Keep an eye on the temperature.||Temperature increase can occur due to a variety of reasons (if not masked by corticosteroids or anti-inflammatory medications) (chemotherapy side effects, disease process, or infection). Early detection of an infectious process allows for quick initiation of suitable treatment.|
|On a regular basis, check all systems (skin, respiratory, and genitourinary) for signs and symptoms of infection.||Early detection and action can help prevent the development of a more catastrophic scenario, such as sepsis.|
|Keep linens dry and wrinkle-free by repositioning them frequently.||Reduces tissue pressure and inflammation, and may help to prevent skin breakdown (potential site for bacterial growth).|
|Encourage appropriate relaxation and exercise.||Limits weariness while encouraging enough mobility to avoid consequences from stasis (pneumonia, decubitus, and thrombus formation).|
|Invasive procedures should be avoided or limited. Follow aseptic procedures.||Reduces the possibility of contamination and prevents infectious pathogens from entering the system.|
|Check the patient CBC for a differential WBC and granulocyte count, as well as platelets if needed.||Chemotherapy, the disease state, or radiation therapy can all decrease bone marrow function. Myelosuppression must be monitored in order to avoid future problems (infection, anemia, or bleeding) and to schedule medicine supply.|
|Collect the cultures as directed.||Determines the causal organism(s) and the relevant treatment.|
|Antibiotics should be given as directed.||It can be used to treat an infection that has been discovered or as a preventative measure in immunocompromised patients.|
Nursing Care Plan for Lymphoma 5
Nursing Diagnosis: Fatigue related to reduced metabolic energy generation, higher energy demands (hypermetabolic state and effects of treatment), psychological/emotional strains that are too much to bear, body chemistry changes as a result of pain and other drugs, as well as chemotherapy secondary to lymphoma as evidenced by unrelenting/overwhelming exhaustion, inability to maintain normal routines, decreased performance, impaired concentration, lethargy/listlessness, and disinterest in the environment.
- The patient will report improved energy levels.
- The patient will perform activities of daily living (ADLs) and engage in preferred activities to the best of one’s ability.
|Lymphoma Nursing Interventions||Rationale|
|Allow the patient to rate their exhaustion on a numeric scale and the time of day when it is the most acute.||Aids in the creation of a fatigue management strategy.|
|Allow for rest moments when planning the patient care. Schedule activities for when the patient is at his or her most energetic. Involve the patient and SO in the scheduling process.||Rest and naps are required on a regular basis to repair and conserve energy. Planning will allow the patient to be active while their energy levels are higher, thereby restoring a sense of well-being and control.|
|With the patient, set reasonable activity goals.||Provides a sense of control as well as a sense of accomplishment.|
|When necessary, aid with self-care; keep bed in low position, walkways clear of furniture; assist with ambulation.||Weakness might make doing ADLs more difficult or put the patient at risk of injury during activities.|
|Encourage the patient to accomplish whatever he or she can (self-bathing, sitting up in chair, walking). As the individual is able, increase their amount of activity.||Increases strength and stamina, allowing the patient to become more active without becoming exhausted.|
|Keep an eye on the patient body’s reaction to activities (changes in BP, heart and respiratory rate).||Tolerance varies a lot depending on the stage of the disease, nutrition, fluid balance, and therapeutic regimen response.|
|Conduct a pain assessment and provide pain relief.||Fatigue can be exacerbated by poorly controlled cancer pain.|
|As needed, administer supplemental oxygen.||Anemia and hypoxemia lower the amount of oxygen available for cellular absorption, contributing to weariness.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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